不同宫颈软化方法应用于绝经后患者宫腔镜手术前宫颈扩张的效果比较

Comparison of different cervical dilation methods for hysteroscopic operation in postmenopausal women

目的比较不同宫颈软化方法在绝经后患者宫腔镜手术前宫颈扩张的效果。方法选取2019年1月至2021年10月浙江省立同德医院收治的行宫腔镜手术的绝经后女性患者105例,分3种方法行术前宫颈软化。其中31例患者采用卡前列甲酯栓(商品名:卡孕栓)1 mg术前30 min塞阴道,为卡孕栓组;39例患者采用宫颈扩张棒(术前60 min常规宫颈消毒后由医生放置一次性宫颈扩张棒),为宫颈扩张棒组;35例患者采用间苯三酚(间苯三酚针80 mg术前10 min静脉推注),为间苯三酚组。观察并比较3组患者宫颈软化程度、无阻力通过金属宫颈扩张棒的直径、宫颈扩张时间、用药后患者腹痛腹胀等不良反应及阴道出血等并发症、心率变化、平均动脉压变化。结果卡孕栓组、宫颈扩张棒组、间苯三酚组患者宫颈软化良好的比例分别为64.5%、89.7%、91.4%。卡孕栓组患者宫颈软化不良的比例低于宫颈扩张棒组和间苯三酚组(均P<0.05)。卡孕栓组、宫颈扩张棒组、间苯三酚组患者无阻力通过金属宫颈扩张棒的直径分别为(6.9±0.4)、(7.0±0.2)、(7.0±0.2)mm,卡孕栓组患者无阻力通过金属宫颈扩张棒的直径小于宫颈扩张棒组、间苯三酚组(均P<0.05),而宫颈扩张棒组与间苯三酚组比较差异无统计学意义(P>0.05)。卡孕栓组、宫颈扩张棒组、间苯三酚组患者宫颈扩张时间分别为(67.1±7.7)、(62.2±5.5)、(61.7±6.2)s,卡孕栓组患者宫颈扩张时间长于宫颈扩张棒组、间苯三酚组(均P<0.05),而宫颈扩张棒组与间苯三酚组比较差异无统计学意义(P>0.05)。间苯三酚组无腹痛腹胀、阴道出血发生,卡孕栓组患者腹痛腹胀发生率高于宫颈扩张棒组(67.7%比35.9%,P<0.05)。宫颈扩张棒组阴道出血发生率高于卡孕栓组组(66.7%比41.9%,P<0.05)。卡孕栓组、宫颈扩张棒组、间苯三酚组患者宫颈软化前后心率增加幅度分别为(8.6±1.6)、(9.8±1.9)、(8.6±1.7)次/min,平均动脉压增加幅度分别为(9.1±1.7)、(10.2±1.7)、(9.1±1.8)mmHg(1 mmHg=0.133 kPa),宫颈扩张棒组患者宫颈软化前后心率增加幅度、平均动脉压增加幅度均大于卡孕栓组、间苯三酚组(均P<0.05),而卡孕栓组、间苯三酚组比较差异无统计学意义(均P>0.05)。结论卡孕栓、一次性宫颈扩张棒、间苯三酚均可使绝经后患者宫腔镜手术前宫颈软化。与卡孕栓相比,间苯三酚宫颈软化效果更佳,宫颈扩张时间短,患者不良反应小,方便安全,不易引起患者心率、血压变化,在绝经后患者宫腔镜手术术前准备中有一定的优势。

Objective To compare the efficacy of different cervical dilation methods for hysteroscopy in postmenopausal women.Methods From January 2019 To October 2021,105 patients undergoing hysteroscopy in Tongde Hospital of Zhejiang Province were enrolled.Patients were assigned to three groups:31 patients in carboprost group received carboprost methylate suppositories 1 mg placed in the vagina 30 min before hysteroscopy,39 patients in lamiken group received disposable cervical dilator(lamiken)inserted in cervix 60 min before hysteroscopy and 35 patients in phloroglucinol group received intravenous infusion of phloroglucinol 80 mg 10 min before hysteroscopy.The extent of preoperative cervical dilatation and side effects were assessed and compared among three groups.Results The softening rate of cervix in carboprost group was lower than that in phloroglucinol group and the lamiken group.The size of the dilators freely passing through the cervix in carboprost group was smaller than that in phloroglucinol and lamiken groups(6.9±0.4 mm vs.7.0±0.2 mm and 7.0±0.2 mm,P<0.05),while there was no significant difference between lamiken group and phloroglucinol group(P>0.05).The cervical dilatation time in carboprost group was longer than that in the lamiken and phloroglucinol groups(67.1±7.7 s vs.62.2±5.5 s and 61.7±6.2 s,P<0.05),while there was no significant difference between lamiken group and phloroglucinol group(P>0.05).In terms of side effects,there were no lower abdominal pain and vaginal bleeding in phloroglucinol group.The incidence of lower abdomi-nal pain and vaginal bleeding in carboprost group were different from that in the lamiken group(67.7%vs.35.9%and 66.7%vs.41.9%,P<0.05).The heart rate increments of in carboprost,phloroglucinol and lamiken groups were(8.6±1.6)bpm,(9.8±1.9)bpmand(8.6±1.7)bpm,respectively,The increments of the mean arterial pressure in three groups were(9.1±1.7)mmHg,(10.2±1.7)mmHg and(9.1±1.8)mmHg(1 mmHg=0.133 kPa),respectively.The lamiken group showed higher changes of the heart rate and mean arterial pressure(P<0.05).All procedures were smooth and there were no operative complications.Conclusion Carboprost methylate suppositories,disposable cervical dilator lamiken and phloroglucinol can completely soften the cervix in postmenopausal women to ensure the hysteroscopic operation.Among three methods phloroglucinol has lower side effect,shorter cervical dilatation time,better cervical dilatation and less increments of heart rate and mean arterial pressure,which is more feasible and safe for hysteroscopic operation in postmenopausal women.